Citation Nr: 21071996 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 12-30 191 DATE: December 2, 2021 ORDER An initial rating of 30 percent for cervical spine fracture with spondylosis, is granted subject to the laws and regulations governing monetary benefits. A rating greater than 30 percent for cervical spine fracture with spondylosis, is denied. A 20 percent disability rating from May 6, 2014 to April 21, 2015, for radiculopathy of the right upper extremity, is granted subject to the laws and regulations governing monetary benefits. A 20 percent disability rating from June 10, 2014 to April 21, 2015, for radiculopathy of the left upper extremity, is granted subject to the laws and regulations governing monetary benefits. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, the Board finds that for the entire period prior to April 21, 2015, the Veteran's cervical spine fracture with spondylosis was manifested by pain productive of forward flexion limited to 10 degrees and combined range of motion of 85 degrees. 2. For the entire period on appeal, the Veteran's cervical spine fracture with spondylosis manifested no worse than pain productive of forward flexion limited to 10 degrees and combined range of motion of 85 degrees. 3. From May 6, 2014 to April 21, 2015, the Veteran's cervical spine disability was productive of no more than mild right upper extremity radiculopathy affecting the radial nerve. 4. From June 10, 2014 to April 21, 2015, the Veteran's cervical spine disability was productive of no more than mild left upper extremity radiculopathy affecting the radial nerve. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation of 30 percent prior to April 21, 2015, for cervical spine fracture with spondylosis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242-5237. 2. The criteria for an initial rating greater than 30 percent for cervical spine fracture with spondylosis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5242-5237. 3. Resolving all doubt in favor of the Veteran, the criteria for a separate 20 percent disability rating, but no higher, for right upper extremity radiculopathy from May 6, 2014 to April 21, 2015, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8514. 4. Resolving all doubt in favor of the Veteran, the criteria for a separate 20 percent disability rating, but no higher, for left upper extremity radiculopathy from June 10, 2014 to April 21, 2015, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, 4.124, 4.124a, Diagnostic Code 8514. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from February 1998 to April 1998 and from April 2001 to January 2009. The appeal for a higher rating for the cervical spine disability was previously denied by the Board in an August 2017 decision. The Veteran appealed to the Court of Appeals for Veterans Claims (Court) which in March 2019 issued a Memorandum Decision vacating and remanding the claims. In January 2020, the Board remanded the claims for further development consistent with the Memorandum Decision. The Board once again remanded the claim in April 2021 as it found the there was not substantial compliance with the January 2020 remand. The Veteran testified before a Veterans Law Judge (VLJ) in May 2014. A transcript of the proceeding has been associated with the claims file. In March 2021, the Board informed the Veteran that the VLJ who held the May 2014 hearing was no longer at the Board and offered the Veteran an opportunity to request a new hearing. The Veteran did not request a new hearing. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disabilities of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). A United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). As in the instant case, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Id. at 126. Although all the evidence has been reviewed, only the most relevant and salient evidence is discussed below. See Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). The Veteran's service-connected cervical disability has been evaluated under DC 5235 and rated 10 percent disabling prior to April 21, 2015, and as 30 percent disabling thereafter. The criteria for rating disabilities of the spine are listed under DCs 5235 to 5243. The code for intervertebral disc syndrome (DC 5243), permits rating under either the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever results in the higher rating when all disabilities are combined. 38 C.F.R. § 4.71a. Under either DC 5235 or DC 5237, a 10 percent evaluation is appropriate where there is forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent evaluation is appropriate where there is forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine is not greater than 170 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent evaluation for forward flexion of the cervical spine of 15 degrees or less or favorable ankylosis of the entire cervical spine. A 40 percent evaluation is appropriate for unfavorable ankylosis of the entire cervical spine. A 100 percent evaluation is appropriate for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a. Normal forward flexion of the cervical segment of the spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right rotation are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. See Note 2, General Rating Formula for Disease and Injuries of the Spine, 38 C.F.R. § 4.71a, Plate V. Any associated neurological abnormalities (e.g., bowel or bladder impairment) are evaluated separately under the appropriate diagnostic code. See Note 1, General Rating Formula for Disease and Injuries of the Spine, 38 C.F.R. § 4.71a. Entitlement to an initial rating greater than 10 percent prior to April 21, 2015, and a rating greater than 30 percent thereafter, for the cervical spine disability. The Veteran's cervical spine disability has been rated 10 percent disabling prior to April 21, 2015. The rating was increased to 30 percent disabling in a September 2015 Rating Decision. Separate compensable ratings are in effect for upper extremity radiculopathy from April 21, 2015. See September 2015 Rating Decision. The appeal before the Board arises from the Veteran's disagreement with the initial rating assigned. For the reasons explained below, the Board resolves all doubt in favor of the Veteran and finds that an initial rating of 30 percent, but no higher, is warranted for the period prior to April 21, 2015; however, a rating greater than 30 percent is not warranted at any time pertinent to the appeal. Additionally, the Board finds that separate compensable ratings are warranted for the left and right upper extremity radiculopathy prior to April 21, 2015. The Veteran was afforded VA examinations in May 2009, April 2015, and August 2021. The Board notes that due to inadequacies with the May 2009 and April 2015 VA examination reports, the Board sought a retrospective opinion for clarification in its January 2020 Remand. A retrospective opinion was obtained in September 2020, but that opinion was also inadequate as the examiner simply restated the range of motion findings noted in the May 2009 VA examination report and did not address the April 2015 VA examination report at all. The Board once again remanded the appeal in April 2021. A VA examination and opinion was obtained in August 2021. The August 2021 VA examiner complied with Correia and Sharp with respect to current findings and offered a retrospective opinion. The August 2021 VA examiner explained that in May 2009, the Veteran's cervical spine disability was mild, and the examiner restated the range of motion findings noted on the May 2009 VA examination. The examiner did not specify at what point pain began or estimate range of motion following repetitive use other than to comment that the disability was expected to worsen with repetitive use. The examiner also noted that the Veteran's condition had progressed from May 2009 to April 2015 with and restated the range of motion findings noted in the April 2015 VA examination report. The examiner impairment was moderately severe and would be expected to be worse on repeated range of motion but was unchanged on weight-bearing and passive range of motion. The examiner did not specify what the worse range of motion finding would be with repeated range of motion. The examiner explained that the initial injury in 2005 improved with treatment but by 2009 was affecting range of motion to a mild degree and progressed by 2015 to moderately severe impairment in range of motion and associated pain. The examiner explained that this was consistent with the development of scar tissue in the neck post healing with progressive limited and painful range of motion. The Board appreciates the August 2021 VA examiner's explanation of the progression of the Veteran's disability but notes that the opinion still did not offer in terms of degrees, the point at which pain began or estimated range of motion following use, during the May 2009 VA examination or the April 2015 VA examination. As the Veteran has reported worsening of the cervical spine disability since the date of entitlement to service connection and the August 2021 VA examiner's opinion supports the statement, the Board has resolved all doubt in favor of the Veteran and applies the August 2021 VA examination range of motion findings to the entire period on appeal. The Board finds that a remand for another retrospective opinion would only unduly delay resolution of the claim. The Board will, however, consider the Veteran's subjective reports made during the May 2009 and April 2015 VA examinations as well as the examiner's objective findings other than ranges of motion. During the May 2009 VA examination, the Veteran reported his neck pains were daily and constant and usually consisted of pressure and occasional stabbing. The Veteran reported that the pain averaged from about 5 out of 10 to 8 out of 10. The Veteran denied any additional limitation with flare-ups. The Veteran also reported that there was no interference with daily activities. The Veteran was found to have a normal gait and normal curvature of the cervical spine. The examiner noted that there was no tenderness to palpation and no deformities. During the April 2015 VA examination, the Veteran reported that he had chronic pain and loss of motion, which was increased with repetitious movement of the neck. The Veteran denied experiencing flare-ups of the cervical spine disability but reported functional loss as chronic cervical pain that increased with movement. The examiner noted the Veteran's report that loss of range of motion resulted in the Veteran having difficulty driving due to rotation loss. The examiner noted pain in every range of motion but that there was no pain with weight-bearing. The examiner noted that there was objective evidence of bilateral muscular tenderness on palpation of the associated soft tissue of the cervical spine. The Veteran was able to perform repetitive use testing with at least three repetitions without any additional loss of function or range of motion. The examiner noted that the Veteran had functional impairment of interference with driving and neck movement. Objective testing during the April 2015 VA examination also revealed full muscle strength on both sides of the Veteran's neck. The examiner noted that the Veteran had IVDS but did not have any physician-prescribed bedrest in the past 12 months. During the August 2021 VA examination, the Veteran denied flare-ups of the cervical spine disability but reported functional impairment after repeated use over time. The Veteran described his functional impairment as the cervical spine disability limiting all driving and desk work after repeated use over time. The VA examiner also noted that the Veteran's range of motion testing resulted in functional loss such that the limitation prevented side gazing, driving, or gazing up and down. Objective findings during the August 2021 VA examination, on passive and active range of motion testing, resulted in forward flexion to 15 degrees, extension to 15 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation to 20 degrees. Pain was noted on all ranges of motion. The examiner noted that the Veteran's pain limited the Veteran's side gaze. The examiner also noted that the Veteran was able to perform repetitive testing with at least three repetitions without any additional loss of range of motion. The examiner did not estimate range of motion in degrees during flare-ups as the Veteran denied experiencing flare-ups. The August 2021 VA examiner also noted that there was no objective evidence of crepitus but that there was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner noted that there was paracervical tenderness and paracervical spasm but that neither resulted in abnormal gait or spinal contour. Muscle strength testing in the right upper extremity was four out of five. The Veteran had full muscle strength in the left upper extremity. The examiner determined that the Veteran did not have any muscle atrophy. The examiner also noted that the Veteran did not have ankylosis. The examiner noted no other neurologic abnormalities other than radiculopathy in the bilateral upper extremities, for which the Veteran is already in receipt of separate compensable ratings. VA and private treatment records do not indicate worse findings than those noted during the August 2021 VA examination. The Board also notes the Veteran's sworn testimony during the June 2014 hearing before the Board, in which the Veteran described functional impairment including not being able to look over either shoulder, making driving dangerous. Transcript page 29. The Veteran also reported that he could look move his head in order to look over his shoulder but that doing so caused a lot of pain. Id. The Veteran reported that he could not look at the sky or otherwise tilt his head back to look up. Transcript page 30. The Veteran opined that he believed he had moderate to severe restriction of movement of the neck. Id. The Veteran reported that he used to be into physical fitness but could no longer do pull-ups, lift weights, or run because the pain and muscle spasms that came with it were too intense. Transcript page 31. The Veteran reported having muscles spasms two to three times per week. Id. The Veteran reported that he had not sought treatment for his neck since he was in service, but his mother testified that the Veteran continued to do the physical therapy exercises that he was taught to do on his own at home even though he was not actively receiving treatment. Transcript page 32. The Veteran's mother also testified that the Veteran could no longer do recreational activities such as water skiing or playing football or other sports. Id. The Veteran's mother also reported that the Veteran has to be very cautious when he plays with his children and his wife has to make sure the children do not jump on him. Transcript page 33. The Veteran's mother reported that she has observed the Veteran wince when he tries to move, on a daily basis. Id. Based on the foregoing, the Board finds that a 30 percent initial disability, but no higher, is warranted for the Veteran's cervical spine disability for the entire period prior to April 21, 2015, but no higher at any point pertinent to the appeal. Again, the Board is applying the August 2021 VA examination report limitation of motion findings to the entire period on appeal. The August 2021 VA examiner noted objective findings of forward flexion to 15 degrees, which meets the requirement for a 30 percent disability rating. The grant of the 30 percent disability rating is the maximum available rating for limitation of motion. Thus, further consideration of functional loss due to pain under 38 C.F.R. §§ 4.40, 4.45, 4.59 and DeLuca v. Brown, 8 Vet.App. 202 (1995) is not required. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The Board has considered whether a higher rating is warranted for ankylosis, but the remaining evidence of record does not demonstrate unfavorable ankylosis of the entire cervical spine or unfavorable ankylosis of the entire spine as required for the next higher 40 percent and 100 percent disability ratings, respectively, at any point pertinent to the appeal. The Board notes that ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003). See also 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, NOTE (5) (defining ankylosis as fixation of a joint in a particular position). In this case, the August 2021 VA examiner specifically found that the Veteran did not have ankylosis of the cervical spine. VA and private treatment records do not indicate otherwise. Further, the Board acknowledges that the March 2019 Memorandum Decision found there to be some question as to whether ankylosis was found during the April 2015 VA examination. However, the Board has reviewed the report and notes that the April 2015 VA examiner answered "no" to the question of whether the Veteran had ankylosis. The only other portion of the report that addressed ankylosis was a section where the examiner was asked to describe any additional factors contributing to disability. The form question included an example of "less movement than normal due to ankylosis." This same example was repeated in reference to all of the joints that were examined. The examiner's language appeared after that section following the line that instructed "please describe." In the description of the contributing factor concerning the cervical spine, the examiner explained that there was interference with driving and neck movement. Again, the April 2015 VA examiner also noted that the Veteran did not have ankylosis. Nevertheless, the Board remanded the claim for further clarification and the August 2021 VA examiner also confirmed that the Veteran did not have ankylosis. The Board also has considered whether a higher rating is warranted for the cervical spine disability under Diagnostic Code 5243 for intervertebral disc syndrome (IVDS). The April 2015 and August 2021 VA examiners confirmed that the Veteran has IVDS. Diagnostic Code 5243 provides that IVDS may be rated under the General Rating Formula for Diseases and Injuries of the Spine, or alternatively on the basis of incapacitating episodes, depending on whichever method results in the higher evaluation when all service-connected disabilities are combined under 38 C.F.R. § 4.25. The rating criteria for IVDS based on incapacitating episodes found in DC 5243 provide for a 10 percent rating when there have been incapacitating episodes having a total duration of at least 1 weeks but less than 2 weeks during the last 12 months. A 20 percent rating requires incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the last 12 months. A higher 40 percent rating requires incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the last 12 months. Whereas an even higher 60 percent rating requires incapacitating episodes having a total duration of at least 6 weeks during the last 12 months. Note (1) to DC 5243 defines an incapacitating episode as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. In this case, the evidence does not establish the Veteran experienced any incapacitating episodes due to his cervical disability, according to this definition. The evidence of record does not show physician-prescribed bed rest at any point pertinent to the appeal. In this regard, the August 2021 VA examiner noted that although the Veteran had IVDS, he had no episodes of IVDS that required bed rest prescribed by a physician in the 12 months prior to the examination. None of the remaining evidence of record demonstrates physician-prescribed bedrest and treatment at any point pertinent to the appeal, much less 4 weeks or more of such bedrest during any pertinent 12-month period. For these reasons, a higher rating is not warranted under DC 5243. The Board has also considered whether the Veteran is entitled to separate ratings for associated objective neurological abnormalities. The Veteran is currently in receipt of a separate ratings for left and right upper extremity radiculopathy under 38 C.F.R. § 4.124a, Diagnostic Code 8514, from the date of the April 2015 VA examination. Resolving doubt in favor of the Veteran, the Board finds that he is entitled to separate 20 percent ratings for radiculopathy prior to April 21, 2015. The Veteran offered sworn testimony during the June 2014 hearing before the Board that he had pain that radiated down both of his arms and made his fingers numb. Transcript page 36. A May 2014 letter from the Veteran's physical therapist, M.M., also noted that the Veteran experienced tingling and numbness along the radial and ulnar nerve pathways of the right upper extremity. Diagnostic Code 8514 provides for 20 percent disability rating in both the major and minor arm for mild radiculopathy affecting the radial nerve. Diagnostic Code 8516 provides for a 10 percent disability rating in both the major and minor arm for radiculopathy affecting the ulnar nerve. Multiple ratings affecting the same arm is prohibited. As the Veteran's separate ratings from April 2015 are already categorized under Diagnostic Code 8514 for radiculopathy affecting the radial nerve, and that code provides for the more beneficial rating for the Veteran, the Board finds that separate ratings for a portion of the period prior to April 21, 2015 are warranted under Diagnostic Code 8514. The Board has considered whether the Veteran experienced bilateral upper extremity radiculopathy for the entire period prior to April 21, 2015 but finds that he has not. Service treatment records indicate that the Veteran's cervical spine disability caused radiating pain and tingling down the right arm on occasion. See e.g. July 2008 service treatment record. Subsequent, treatment records dated in August 2008, September 2008, and October 2008 note that the Veteran's neck pain was intermittent and no longer radiated down the right arm. In the November 2008 Report of Medical History, the Veteran reported that he had experienced numbness and tingling down to his fingertips during service. The Veteran and his mother offered sworn testimony that he did not seek medical treatment immediately after service but that he continued to do the physical therapy exercises he had learned while he was in service. Transcript page 32. The May 2009 VA examination report noted that the Veteran denied any radiating neck pain or numbness in the arms. However, as noted above, by the time of the May 2014 letter from the Veteran's physical therapist, the Veteran was again experiencing pain and numbness down the right arm. Shortly thereafter, at the time of the June 2014 hearing before the Board, the Veteran reported experiencing pain and numbness down both arms. VA and private treatment records dated post-service and do not indicate an objective diagnosis of cervical spine radiculopathy in the left upper extremity prior to the April 2015 VA examination. Following an interview with the Veteran and objective testing, the April 2015 VA examiner determined that the Veteran had moderate radiculopathy in each upper extremity. This was the first, post-service, objective finding of cervical spine radiculopathy. Resolving doubt in favor of the Veteran, the Board finds that the Veteran is entitled to a separate 20 percent disability rating for mild radiculopathy in the right upper extremity from May 6, 2014, the date of the letter from the Veteran's physical therapist, M.M. The Board also resolves doubt and finds a separate 20 percent disability rating is warranted for left upper extremity radiculopathy from June 10, 2014, the date of the Board hearing. The Board finds the Veteran's and his mother's testimony to be competent and credible; however, as the evidence does not indicate an objective finding of left arm cervical spine radiculopathy or moderate right arm cervical spine radiculopathy prior to April 21, 2015, ratings for more than mild radiculopathy prior to April 21, 2015, are not warranted. The Board has also considered whether separate ratings are warranted for any other associated neurological abnormalities but finds that they are not. In reaching this conclusion, the Board acknowledges that the Veteran's physical therapist, M.M., noted that the Veteran experienced migraine headaches. However, a separate rating for migraines has already been granted as secondary to the Veteran's service-connected traumatic brain injury, not cervical spine disability. Moreover, the August 2021 VA examiner did not indicate that the Veteran's migraine headaches were a neurological abnormality caused by the cervical spine. Thus, the issue of entitlement to a separate rating for headaches prior to April 2015 is not before the Board. The Board acknowledges the Veteran's belief that his symptoms are of such severity as to warrant a higher rating; however, disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability is evaluated, more probative than the Veteran's assessment of the severity of his disabilities. To the extent that the Veteran's representative suggested in the February 2021 Informal Hearing Presentation that the Board is obligated to consider the applicability of an extraschedular rating, the Board has considered this argument and has concluded that no such referral is warranted. The Veteran's reduction in functioning resulting from his cervical spine disorder is fully contemplated by the applicable schedular criteria. There is nothing in the record to suggest that his cervical spine disability is so exceptional or unusual as to render impractical the application of these regular standards, and neither the Veteran nor his representative has identified any symptoms that are not otherwise contemplated by the schedular criteria. See, e.g., Thun v. Peake, 22 Vet. App. 111 (2008). Accordingly, referral for extraschedular consideration is not warranted. 38 C.F.R. § 3.321; Thun, 22 Vet. App. at 111. In sum, the Board resolves doubt and finds that the preponderance of the evidence supports an initial 30 percent disability rating prior to April 21, 2015 as well as separate 20 percent disability rating for right upper extremity radiculopathy from May 6, 2014 and a separate 20 percent disability rating for left upper extremity radiculopathy from July 10, 2014 but does not support higher ratings at any time pertinent to the appeal. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Donna D. Ebaugh, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.